U.S. patent number 8,870,867 [Application Number 13/070,391] was granted by the patent office on 2014-10-28 for articulable electrosurgical instrument with a stabilizable articulation actuator.
This patent grant is currently assigned to Aesculap AG. The grantee listed for this patent is Lawrence Kerver, Brandon Loudermilk, Brian Tang, Erik Walberg. Invention is credited to Lawrence Kerver, Brandon Loudermilk, Brian Tang, Erik Walberg.
United States Patent |
8,870,867 |
Walberg , et al. |
October 28, 2014 |
Articulable electrosurgical instrument with a stabilizable
articulation actuator
Abstract
Embodiments of the technology provide an articulable
electrosurgical instrument and methods of performing electrosurgery
with an articulating capability. The electrosurgical instrument
includes an elongated shaft having an end effector associated with
a distal end thereof that is able to deliver energy to a target
tissue site. An articulable joint is positioned between that shaft
and the end effector. Articulation of the articulable joint is
controlled by a stabilizable articulation actuator, which may
include a rotatably stabilizable disk residing within a well. The
end effector may take the form of forceps including an upper and a
lower jaw; the jaws are configured to grasp target tissue and to
deliver energy, such as radiofrequency energy. In some of these
instruments, the end effector is adapted to seal tissue by the
application of radiofrequency energy, and then to cut through the
sealed tissue portion.
Inventors: |
Walberg; Erik (Redwood City,
CA), Kerver; Lawrence (Los Gatos, CA), Tang; Brian
(Fremont, CA), Loudermilk; Brandon (San Francisco, CA) |
Applicant: |
Name |
City |
State |
Country |
Type |
Walberg; Erik
Kerver; Lawrence
Tang; Brian
Loudermilk; Brandon |
Redwood City
Los Gatos
Fremont
San Francisco |
CA
CA
CA
CA |
US
US
US
US |
|
|
Assignee: |
Aesculap AG (Tuttlingen,
DE)
|
Family
ID: |
45841485 |
Appl.
No.: |
13/070,391 |
Filed: |
March 23, 2011 |
Prior Publication Data
|
|
|
|
Document
Identifier |
Publication Date |
|
US 20110230875 A1 |
Sep 22, 2011 |
|
Related U.S. Patent Documents
|
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
|
12027231 |
Feb 6, 2008 |
|
|
|
|
61382868 |
Sep 14, 2010 |
|
|
|
|
Current U.S.
Class: |
606/51;
606/52 |
Current CPC
Class: |
A61B
18/1445 (20130101); A61B 17/29 (20130101); A61B
17/295 (20130101); A61B 2017/2946 (20130101); A61B
2017/003 (20130101); A61B 2017/2933 (20130101); A61B
2018/1455 (20130101); A61B 2018/1412 (20130101); A61B
2017/2923 (20130101); A61B 2017/00327 (20130101); A61B
2017/2927 (20130101); A61B 2018/0063 (20130101); A61B
2034/715 (20160201); A61B 2090/0811 (20160201) |
Current International
Class: |
A61B
18/12 (20060101) |
Field of
Search: |
;606/27,34,41,51,52 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
2061215 |
|
Aug 1992 |
|
CA |
|
1826083 |
|
Aug 2006 |
|
CN |
|
0440385 |
|
Aug 1991 |
|
EP |
|
0487269 |
|
May 1992 |
|
EP |
|
0502268 |
|
Sep 1992 |
|
EP |
|
0562195 |
|
Sep 1993 |
|
EP |
|
0658333 |
|
Jun 1995 |
|
EP |
|
0923907 |
|
Jun 1999 |
|
EP |
|
0833593 |
|
Feb 2001 |
|
EP |
|
0737446 |
|
Dec 2002 |
|
EP |
|
0717960 |
|
Feb 2003 |
|
EP |
|
0869742 |
|
May 2003 |
|
EP |
|
0873089 |
|
Oct 2003 |
|
EP |
|
0742696 |
|
Nov 2003 |
|
EP |
|
1041933 |
|
Mar 2004 |
|
EP |
|
1004277 |
|
Jul 2004 |
|
EP |
|
0959786 |
|
Sep 2004 |
|
EP |
|
0913126 |
|
Oct 2004 |
|
EP |
|
0956827 |
|
Oct 2004 |
|
EP |
|
1472984 |
|
Nov 2004 |
|
EP |
|
1621146 |
|
Feb 2006 |
|
EP |
|
1645237 |
|
Apr 2006 |
|
EP |
|
0875209 |
|
May 2006 |
|
EP |
|
1293170 |
|
Jun 2006 |
|
EP |
|
1293169 |
|
Jul 2006 |
|
EP |
|
1064886 |
|
Aug 2006 |
|
EP |
|
1767164 |
|
Mar 2007 |
|
EP |
|
1518498 |
|
Dec 2007 |
|
EP |
|
1862138 |
|
Dec 2007 |
|
EP |
|
1039862 |
|
May 2008 |
|
EP |
|
1532933 |
|
May 2008 |
|
EP |
|
1707143 |
|
Jun 2008 |
|
EP |
|
1518499 |
|
Aug 2008 |
|
EP |
|
1632192 |
|
Mar 2009 |
|
EP |
|
1486177 |
|
Aug 2009 |
|
EP |
|
1852081 |
|
Aug 2009 |
|
EP |
|
1747761 |
|
Oct 2009 |
|
EP |
|
2106764 |
|
Oct 2009 |
|
EP |
|
2003088534 |
|
Mar 2003 |
|
JP |
|
2004049566 |
|
Feb 2004 |
|
JP |
|
2005144193 |
|
Jun 2005 |
|
JP |
|
WO92/22257 |
|
Dec 1992 |
|
WO |
|
WO93/08754 |
|
May 1993 |
|
WO |
|
WO94/00060 |
|
Jan 1994 |
|
WO |
|
WO94/26179 |
|
Nov 1994 |
|
WO |
|
WO95/02371 |
|
Jan 1995 |
|
WO |
|
WO96/05776 |
|
Feb 1996 |
|
WO |
|
WO96/16605 |
|
Jun 1996 |
|
WO |
|
WO96/23449 |
|
Aug 1996 |
|
WO |
|
WO97/24073 |
|
Jul 1997 |
|
WO |
|
WO97/24074 |
|
Jul 1997 |
|
WO |
|
WO98/12999 |
|
Apr 1998 |
|
WO |
|
WO98/43548 |
|
Oct 1998 |
|
WO |
|
WO98/53750 |
|
Dec 1998 |
|
WO |
|
WO99/23933 |
|
May 1999 |
|
WO |
|
WO99/52459 |
|
Oct 1999 |
|
WO |
|
WO99/56646 |
|
Nov 1999 |
|
WO |
|
WO00/13192 |
|
Mar 2000 |
|
WO |
|
WO00/13193 |
|
Mar 2000 |
|
WO |
|
WO01/12090 |
|
Feb 2001 |
|
WO |
|
WO01/35846 |
|
May 2001 |
|
WO |
|
WO01/54602 |
|
Aug 2001 |
|
WO |
|
WO01/58372 |
|
Aug 2001 |
|
WO |
|
WO01/58373 |
|
Aug 2001 |
|
WO |
|
WO01/82812 |
|
Nov 2001 |
|
WO |
|
WO02/24092 |
|
Mar 2002 |
|
WO |
|
WO02/058542 |
|
Aug 2002 |
|
WO |
|
WO02/067798 |
|
Sep 2002 |
|
WO |
|
WO-02080783 |
|
Oct 2002 |
|
WO |
|
WO03/088806 |
|
Oct 2003 |
|
WO |
|
WO03/103522 |
|
Dec 2003 |
|
WO |
|
WO2004/032596 |
|
Apr 2004 |
|
WO |
|
WO2004/032776 |
|
Apr 2004 |
|
WO |
|
WO2004/073490 |
|
Sep 2004 |
|
WO |
|
WO2004/098383 |
|
Nov 2004 |
|
WO |
|
WO 2004/105578 |
|
Dec 2004 |
|
WO |
|
WO2005/009213 |
|
Feb 2005 |
|
WO |
|
WO2005/034729 |
|
Apr 2005 |
|
WO |
|
WO2005/079901 |
|
Sep 2005 |
|
WO |
|
WO2005/115251 |
|
Dec 2005 |
|
WO |
|
WO2006/060431 |
|
Jun 2006 |
|
WO |
|
WO2007/002227 |
|
Jan 2007 |
|
WO |
|
WO2007/082061 |
|
Jul 2007 |
|
WO |
|
WO-2007146842 |
|
Dec 2007 |
|
WO |
|
WO2008/094554 |
|
Aug 2008 |
|
WO |
|
WO2008/124112 |
|
Oct 2008 |
|
WO |
|
Other References
European Application Serial No. 09707446.2, Supplementary European
Search Report mailed Oct. 9, 2012. cited by applicant .
First Office Action for Chinese Application No. CN 200980104230
Dated Jan. 18, 2012 (w/English Language Translation). cited by
applicant .
(ArthroCare); ArthroCare receives clearance to market
coblation-based devices for gynecology and laparoscopic surgery:
clearance includes plasma forceps and 21 specific indications;
Business Wire; p. 524; Oct. 25, 2001. cited by applicant .
(Business Wire); Radiofrequency energy proven effective against
leading cause of obstructive sleep apnea; Business Wire; p09140175;
Sep. 14, 1998. cited by applicant .
(Curon); Curon announces the publication of data supporting
durability and effectiveness of STRETTA.RTM. system--positive one
year follow-up data of U.S. clinical trial published in
gastrointestinal endoscopy; PR Newswire; pNYTH10307022002; Feb. 7,
2002. cited by applicant .
(Curon); Curon medical announces presentation of positive clinical
study results of STRETTA.RTM. procedure for gastroesophageal reflux
disease (GERD); PR Newswire; pNYW07920032002; Mar. 20, 2002. cited
by applicant .
(Enable); Enable medical introduces second generation bipolar
scissors; Health Industry Today; pNA; Dec. 1998. cited by applicant
.
(Everest) Everest medical announces introduction of 3mm bipolar
forceps; PR Newswire; p1002MNW021; Oct. 2, 1996. cited by applicant
.
(Everest) Everest medical discusses patent status: forecasts $1
million revenue first quarter: introduces next generation bipolar
scissors; PR Newswire; pN/A; Mar. 31, 1994. cited by applicant
.
(Everest) Everest medical introduces new Quadripolar} cutting
forceps at the global congress for gynecologic endoscopy meeting;
PR Newswire; p. 8927; Nov. 8, 1999. cited by applicant .
(Everest) Everest medical reports record first quarter results:
introduces next generation bipolar scissors; PR Newswire; pN/A;
Apr. 19, 1994. cited by applicant .
(Everest) Quadripolar cutting forceps introduced by Everest
Medical; Health Industry Today; vol. 63; No. 1; pNA; Jan. 2000.
cited by applicant .
(Novare); U.S. patent issued for Novare Surgical Systems
Cygnet.RTM. surgical clamp: Novare signs multi-year supply
agreement with Boston Scientific; PR Newswire; pNA; Sep. 2, 2003.
cited by applicant .
Aoki et al.; Thoracoscopic resection of the lung with the
ultrasonic scalpel; Ann thorac Surg; vol. 67; No. 4; pp. 1181-1183;
Apr. 1999. cited by applicant .
Bergamaschi et al.; Laparoscopic intracorporeal bowel resection
with ultrasound versus electrosurgical dissection; JSLS; vol. 5;
No. 1; pp. 17-20; Jan.-Mar. 2001. cited by applicant .
Eichfeld et al.; Evaluation of ultracision in lung metastatic
surgery; Ann Thorac Surg; vol. 70; No. 4; pp. 1181-1184; Oct. 2000.
cited by applicant .
ERBE Elektromedizin GmbH; ERBE BiClamp Brochure;
http://www.erbe-med.com/erbe/media/Marketingmaterialien/85100-139.sub.--E-
RBE.sub.--EN.sub.--BiClamp.sub.--D024676.pdf; downloaded Jan. 24,
2011; 6 pgs. cited by applicant .
Gyrus ACMI (an Olympus Company); PKS Seal (product page);
http://www.gyrusacmi.com/user/display.cfm?display=product&pid=9024;
downloaded Jan. 24, 2011; 1 page. cited by applicant .
Gyrus Medical; Cutting Forceps (Product Information); downloaded
Oct. 5, 2005. cited by applicant .
Gyrus Medical; LP Scissors (Product Information); downloaded Oct.
5, 2005. cited by applicant .
Gyrus Medical; Lyons} Dissecting Forceps (Product Information);
downloaded Oct. 5, 2005. cited by applicant .
Gyrus Medical; Micro/Macro-Jaw Forceps (Product Information);
downloaded Oct. 5, 2005. cited by applicant .
Gyrus Medical; Seal} Open Forceps (Product Information); downloaded
Oct. 5, 2005. cited by applicant .
Hayashi et al.; Experimental and clinical evaluation of the
harmonic scalpel in thoracic surgery; Kurume Med J; vol. 46; No. 1;
pp. 25-29; 1999. cited by applicant .
Hefni et al.; Safety and efficacy of using the ligasure vessel
sealing system for securing the pedicles in vaginal hysterectomy:
randomized controlled trial; BJOG; vol. 112; No. 3; pp. 329-333;
Mar. 2005. cited by applicant .
Heniford et al.; Initial results with an electrothermal bipolar
vessel sealer; Surg Endosc; vol. 15; No. 8; pp. 799-801; Aug. 2001.
cited by applicant .
Johnson & Johnson Gateway, LLC; The Gynecare Versapoint
(Product Information);
http://jnjgateway.com/home/jhtml?loc=USENG&page=viewContent&id=edea000100-
001747&parentid=fc0de00100000334; downloaded Oct. 20, 2005.
cited by applicant .
Kamat et al.; Superiority of electrocautery over the suture method
for achieving cervical cone bed hemostasis; Obstet Gynecol; vol.
102; No. 4; pp. 726-730; Oct. 2003. cited by applicant .
Kennedy et al.; High-burst-strength, feedback-controlled bipolar
vessel sealing; Surg Endosc; vol. 12; No. 6; pp. 876-878; Jun.
1998. cited by applicant .
Kim et al.; Design and fabrication of a locomotive mechanism for
capsule-type endoscopes using shape memory alloys (SMAs); IEEE/ASME
Trans on Mechatronics; vol. 10; No. 1; pp. 77-86; Feb. 2005. cited
by applicant .
Kovac; Transvaginal hysterectomy: rationale and surgical approach;
Obstet. Gynecol.; vol. 103; pp. 1321-1325; 2004. cited by applicant
.
Landman et al.; Evaluation of a vessel sealing system, bipolar
electrosurgery, harmonic scalpel, . . . in a porcine model; J.
urol; vol. 169; No. 2; pp. 697-700; Feb. 2003. cited by applicant
.
Levy, et al.; Update on hysterectomy: new technology and
techniques; A Supp. To OBG Maganagement; Feb. 2003. cited by
applicant .
Levy, et al.; Use of a new vessel ligation device during vaginal
hysterectomy (presentation abstract); presented at FIGO 2000;
Washington, D.C.; 2000. cited by applicant .
Lin et al.; Application of ultrasonic scalpel in gynecologic
operative laparoscopy; Chin Med J (Engl.); vol. 114; No. 12; pp.
1283-1285; Dec. 2001. cited by applicant .
Live Tissue Connect Technologies; company profile;
(http://www.onemedplace.com/database/compdisplay.sub.--print.php?CompanyI-
D=11508); 1 pg.; Oct. 19, 2010 (downloaded Feb. 7, 2011). cited by
applicant .
Lyons et al.; An innovative bipolar instrument for laparoscopic
surgery; JSLS; vol. 9; No. 1; pp. 39-41; Jan.-Mar. 2005. cited by
applicant .
McClurken et al.; Collagen shrinkage and vessel sealing; Technical
brief #300. Dover, NH: Tissue Link Medical; 2001. cited by
applicant .
Nojarov et al.; High-energy scissors mode; Phys Rev C Nucl Phys;
vol. 51; No. 5; pp. 2449-2456; 1995
(http://arxiv.org/abs/nucl-th/9502001v1). cited by applicant .
Parikh et al.; Three dimensional virtual reality model of the
normal female pelvic floor; Annals of Bimedical Engineering; vol.
32; pp. 292-296; Feb. 2004. cited by applicant .
Refractec, Inc.; Medical use of radiofrequency (RF) energy;
(http://www.locateadoc.com/Site.sub.--Tools/Print.cfm); 2 pgs.;
Aug. 23, 2008 (downloaded Feb. 7, 2011). cited by applicant .
SAGES 2001 Hands-On Course I--Taking it the next level: advanced
laparoscopic techniques;
http://wvvw.sages.org/01program/syllabi/ho1/ho1.html#schirme; 24
pgs.; downloaded Oct. 5, 2005. cited by applicant .
SAGES 2001 Nurses Program, Session 1;
http://sages.org/01program/syllabi/nurse/nurse.html; downloaded
Jan. 24, 2011; 5 pgs. cited by applicant .
Srisombut et al.; Laparoscopic hysterectomy using laparoscopic
coagulating shears: experience of 15 cases; J. Med Assoc Thai; vol.
83; No. 8; pp. 915-920; Aug. 2000. cited by applicant .
Surgrx 510(K) Summary (# K031133); Palo Alto, CA; 5 pgs.; Jul. 3,
2003. cited by applicant .
Treat; A new thermal device for sealing and dividing blood vessels;
http://www.starioninstruments.com/PDFs/Treat.pdf; downloaded Jun.
29, 2005; 2 pgs. cited by applicant .
Tyco Healthcare; The LigaSure Vessel Sealing System (Brochure);
Apr. 2002; 8 pgs. cited by applicant .
Valleylab Products; Valleylab Products--Electrosurgical Forceps:
The surgeon's choice for quality and precision (product
information);
http://www.valleylab.com/product/es/accessories/forceps.sub.--over.html;
downloaded Oct. 20, 2005. cited by applicant .
Valleylab Products; Valleylab Products--Ligasure} vessel sealing
system (product information);
http://www.valleylab.com/product/vessel.sub.--seal/index.html;
downloaded Oct. 20, 2005. cited by applicant .
Nezhat et al.; U.S. Appl. No. 08/948,282 entitled "Method and
systems for organ resection," filed Oct. 9, 1997. cited by
applicant .
Eder, Joseph C.; U.S. Appl. No. 12/200,798 entitled "Assisted
systems and methods for performing transvaginal hysterectomies,"
filed Aug. 28, 2008. cited by applicant .
Koss et al.; U.S. Appl. No. 12/748,229 entitled "Impedance mediated
power delivery for electrosurgery," filed Mar. 26, 2010. cited by
applicant .
Koss et al.; U.S. Appl. No. 12/907,646 entitled "Impedance mediated
control of power delivery for electrosurgery," filed Oct. 19, 2010.
cited by applicant .
Walberg, Erik; U.S. Appl. No. 13/021,633 entitled "Laparoscopic
radiofrequency surgical device," filed Feb. 4, 2011. cited by
applicant .
Van Lue et al.; U.S. Appl. No. 13/110,848 entitled "Electrosurgical
tissue sealing augmented with a seal-enhancing composition," filed
May 18, 2011. cited by applicant.
|
Primary Examiner: Peffley; Michael
Assistant Examiner: Fowler; Daniel
Attorney, Agent or Firm: RatnerPrestia
Parent Case Text
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a continuation in part of U.S. patent
application Ser. No. 12/027,231 of Kerver et al., entitled "METHOD
AND APPARATUS FOR ARTICULATING THE WRIST OF A LAPAROSCOPIC GRASPING
INSTRUMENT", filed on Feb. 6, 2008. The present application further
claims priority to U.S. Provisional Patent Application No.
61/382,868 of Walberg et al., entitled "ARTICULABLE ELECTROSURGICAL
INSTRUMENT", filed on Sep. 14, 2010.
Claims
We claim:
1. An electrosurgical instrument, comprising: an elongated shaft
having an end effector associated with a distal end thereof and a
handle associated with a proximal end thereof, the end effector
enabled to deliver radiofrequency energy to a target site; an
articulable joint positioned between the shaft and the end
effector, the joint configured to articulate the end effector
angularly within an arc of articulation, the articulable joint
comprising at least one pivotable link positioned between a distal
end of the shaft and a proximal end of the end effector; a
stabilizable articulation actuator disposed proximal to the
articulable joint and adapted to control the angle of articulation
of the articulable joint; and at least two force transfer member
portions operably connected at their proximal end to the
articulation actuator, and operably connected at their distal end
through the articulable joint to a proximal portion of the end
effector, thereby allowing rotational movement of the articulation
actuator to be translated into articulating movement of the end
effector, wherein the stabilizable articulation actuator is
configured to stabilize the articulable joint at a stable angle by
stabilizing the force transfer member portions, the stable angle of
the articulable joint being any one of a set of angles spaced apart
at intervals within the arc of joint articulation, wherein the
stabilizable articulation actuator comprises: a rotationally
stabilizable disk; and a lever configured to rotate the
rotationally stabilizable disk, the lever comprising two opposing
arms, each arm of the lever connected to one of the at least two
force transfer member portions, the lever configured such that its
rotation moves a first transfer member portion in a proximal
direction and a second member portion in a distal direction,
wherein the stabilizable articulation actuator further comprises a
force member tensioning mechanism associated with the rotatable
lever, the force member tensioning mechanism configured to apply
tension to the at least two force transfer members, and wherein the
force member tensioning mechanism comprises a spring plate
comprising two opposing arms, at least one of the at least two
force transfer member portions being threaded through each arm of
the rotatable lever, through the spring plate, and terminating
proximal to the spring plate.
2. The instrument of claim 1, wherein the lever is a finger
operable lever.
3. The instrument of claim 2, wherein the rotationally stabilizable
disk and a well in which it sits are configured such that the disk
can be stabilized at a position by a level of resistance to
rotation of the disk that can be overcome by application of torque
to the finger operable lever.
4. The instrument of claim 2, wherein the rotationally stabilizable
disk and a well in which it sits are configured such that rotation
of the disk through a stable position requires applying a torque to
the mechanism via the finger operable lever that is greater than
the torque required to rotate the disk through portions of the arc
between the stable angle positions.
5. The instrument of claim 1, further comprising a shaft rotator
disposed proximal to the articulable joint, the shaft rotator
configured to rotate the shaft with respect to the handle, the
stabilizable articulation actuator disposed within or in
association with the shaft rotator.
6. The instrument of claim 1, wherein the rotationally stabilizable
disk comprises at least one spring portion biased circumferentially
outwardly against a wall of a circular well, a circumferentially
peripheral edge of the spring portion comprising one or more teeth,
the wall of the circular well comprising one or more detents, the
one or more teeth and the one or more detents configured to be
mutually engageable.
7. The instrument of claim 1, wherein the rotationally stabilizable
disk and a well in which it sits are adapted to stabilize rotation
of the disk at any one position of a set of stable positions spaced
apart at intervals within an arc of disk rotation.
8. The instrument of claim 7, wherein the arc of rotation of the
rotationally stabilizable disk encompasses about 90 degrees,
including about 45 degrees in either direction from a neutral
position wherein the finger operable lever is orthogonal to the
shaft.
9. The instrument of claim 7, wherein the articulable joint is
adapted to stabilize at a set of stable positions spaced apart at
intervals that substantially correspond to the stable positions of
the rotationally stabilizable disk.
10. The instrument of claim 1, wherein the rotationally
stabilizable disk is seated in a well.
11. The instrument of claim 1, wherein the articulation actuator is
further configured to stabilize the end effector at a stable angle,
the stable angle of the end effector being any one of a set of
angles spaced apart at intervals within the arc of end effector
articulation.
12. The instrument of claim 1, wherein the at least one link of the
articulable joint and the distal end of the shaft and the proximal
end of the end effector comprise ball-like projections engageable
in complementary grooves.
13. The instrument of claim 1, wherein the articulable joint
comprises a set of two or more interconnected links positioned
between the distal end of the shaft and the proximal end of the end
effector.
14. The instrument of claim 1, wherein the articulable joint is
configured to pivot the end effector within an arc of about 90
degrees, the 90 degree arc including about 45 degrees in either
direction from a neutral position.
15. The instrument of claim 1, wherein the end effector is a set of
jaws, the instrument further comprising a blade and a blade drive
member collectively configured to be able to separate tissue at a
target site into two portions when the tissue is being grasped by
the set of jaws.
16. The instrument of claim 15, wherein the blade is configured to
reside in a home position distal to the articulable joint, and to
be able to move distally within the set of jaws.
17. The instrument of claim 15, wherein the blade driving member is
disposed through the articulable joint, and operable in any
position of articulation.
18. The instrument of claim 15, wherein the blade driving member is
configured as a push and pull mechanism.
19. An electrosurgical instrument, comprising: an elongated shaft
having a set of jaws associated with a distal end thereof, the set
of jaws enabled to deliver radiofrequency energy to a target site;
an articulable joint positioned between the shaft and the set of
jaws, the joint configured to articulate the set of jaws angularly
within an arc of articulation, the articulable joint comprising at
least one pivotable link positioned between a distal end of the
shaft and a proximal end of the set of jaws; a stabilizable
articulation actuator disposed proximal to the shaft adapted to
control the angle of articulation of the articulable joint; and at
least two force transfer member portions operably connected at
their proximal end to the articulation actuator, and operably
connected at their distal end through the articulable joint to a
proximal portion of the end effector, thereby allowing rotational
movement of the articulation actuator to be translated into
articulating movement of the end effector, wherein the stabilizable
articulation actuator is configured to stabilize the articulable
joint at a stable angle by stabilizing the force transfer member
portions, the stable angle of the articulable joint being any one
of a set of angles spaced apart at intervals within the arc of
joint articulation, wherein the stabilizable articulation actuator
comprises: a rotationally stabilizable disk; and a lever configured
to rotate the rotationally stabilizable disk the lever comprising
two opposing arms, each arm of the lever connected to one of the at
least two force transfer member portions, the lever configured such
that its rotation moves a first transfer member portion in a
proximal direction and a second member portion in a distal
direction, wherein the stabilizable articulation actuator further
comprises a force member tensioning mechanism associated with the
rotatable lever, the force member tensioning mechanism configured
to apply tension to the at least two force transfer members, and
wherein the force member tensioning mechanism comprises a spring
plate comprising two opposing arms, at least one of the at least
two force transfer member portions being threaded through each arm
of the rotatable lever, through the spring plate, and terminating
proximal to the spring plate.
20. An electrosurgical instrument, comprising: a set of jaws
enabled to deliver radiofrequency energy to a target site; an
articulable joint positioned distal to a base, the joint configured
to articulate the set of jaws angularly within an arc of
articulation, the articulable joint comprising at least one
pivotable link positioned between the base and a proximal end of
the set of jaws; a stabilizable articulation actuator disposed in
association with the base and adapted to control the angle of
articulation of the articulable joint; and at least two force
transfer member portions operably connected at their proximal end
to the articulation actuator, and operably connected at their
distal end through the articulable joint to a proximal portion of
the end effector, thereby allowing rotational movement of the
articulation actuator to be translated into articulating movement
of the end effector, wherein the stabilizable articulation actuator
is configured to stabilize the articulable joint at a stable angle
by stabilizing the force transfer member portions, the stable angle
of the articulable joint being any one of a set of angles spaced
apart at intervals within the arc of joint articulation, wherein
the stabilizable articulation actuator comprises: a rotationally
stabilizable disk; and a lever configured to rotate the
rotationally stabilizable disk, the lever comprising two opposing
arms, each arm of the lever connected to one of the at least two
force transfer member portions, the lever configured such that its
rotation moves a first transfer member portion in a proximal
direction and a second member portion in a distal direction, and
wherein the stabilizable articulation actuator further comprises a
force member tensioning mechanism associated with the rotatable
lever, the force member tensioning mechanism configured to apply
tension to the at least two force transfer members, and wherein the
force member tensioning mechanism comprises a spring plate
comprising two opposing arms, at least one of the at least two
force transfer member portions being threaded through each arm of
the rotatable lever, through the spring plate, and terminating
proximal to the spring plate.
21. A method of electrosurgical tissue sealing, comprising: moving
a set of electrosurgical jaws of an electrosurgical instrument into
a proximity of a target tissue site, the set of jaws positioned
distal to an articulable joint; rotating a stabilizable
articulation actuator with a finger operable lever to a desired
rotational position, thereby articulating the articulable joint to
a desired angle of articulation; and stabilizing the stabilizable
articulation actuator in the desired rotational position, thereby
stabilizing the articulable joint in the desired angle of
articulation, wherein the stabilizable articulation actuator
comprises: a rotationally stabilizable disk; the finger operable
lever rotating the rotationally stabilizable disk, the lever
comprising two opposing arms, each arm of the lever connected to
one of the at least two force transfer member portions, the lever
configured such that its rotation moves a first transfer member
portion in a proximal direction and a second member portion in a
distal direction, wherein the stabilizable articulation actuator
further comprises a force member tensioning mechanism associated
with the rotatable finger-operable lever, the force member
tensioning mechanism configured to apply tension to the at least
two force transfer members, and wherein the force member tensioning
mechanism comprises a spring plate comprising two opposing arms, at
least one of the at least two force transfer member portions being
threaded through each arm of the rotatable finger-operable lever,
through the spring plate, and terminating proximal to the spring
plate.
22. The method of claim 21, wherein rotating the stabilizable
articulation actuator comprises rotating the rotationally
stabilizable disk.
23. The method of claim 21, wherein stabilizing the stabilizable
articulation actuator comprises stabilizing the rotationally
stabilizable disk.
24. The method of claim 21, further comprising articulating the set
of jaws in accordance with rotating the stabilizable articulation
actuator.
25. The method of claim 21, further comprising stabilizing the set
of jaws in a desired angle of articulation in accordance with
stabilizing the articulable joint in the desired angle of
articulation.
26. The method of claim 21, wherein the desired angle of
articulation of the articulable joint is one such that the jaws are
in an angle such that, when closed, the jaws will grasp the target
tissue.
27. The method of claim 21 further comprising rotating the
finger-operable lever associated with the articulation actuator,
thereby rotating the rotationally stabilizable disk.
28. The method of claim 21, further comprising driving movement of
at least two force transfer member portions in accordance with
rotating the rotationally stabilizable disk.
29. The method of claim 21, wherein articulating the set of jaws
comprises pivoting the set of jaws within an arc of about 45
degrees in either direction from a centerline within a plane,
thereby providing a total pivotable range of about 90 degrees.
30. The method of claim 21, wherein the articulable joint comprises
one or more pivotable links positioned between a distal end of a
shaft of the instrument and a proximal end of the jaws, and wherein
articulating the articulable joint comprises pivoting the one or
more pivotable links with respect to each other or with respect to
the distal end of the shaft or the proximal end of the jaws.
31. The method of claim 21, wherein the jaws, when closed, have a
central longitudinal axis, and wherein moving the set of jaws into
the proximity of the target site comprises rotating the set of jaws
about their central longitudinal axis.
32. The method of claim 21, wherein moving the set of jaws into the
proximity of the target site comprises advancing the jaws through a
trocar into a laparoscopic operating space.
33. The method of claim 21, wherein stabilizing the stabilizable
articulation actuator comprises rotating the lever of the
stabilizable articulation actuator through a portion of an arc of
relatively low rotational resistance until the lever encounters a
position of relatively high rotational resistance, such position
being a position of articulated stability.
34. The method of claim 21, wherein stabilizing the stabilizable
articulation actuator comprises rotating the lever of the
stabilizable actuator through a portion of an arc that may include
one or more regions of moderate rotational resistance and one or
more regions of high rotational resistance, until the lever
encounters a particular position of high rotational resistance
wherein the jaws are in a desired position of articulation.
35. A method of articulating and stabilizing an electrosurgical end
effector, wherein articulating the end effector comprises: rotating
a finger operable lever; rotating a stabilizable rotatable disk;
moving force transfer member portions translationally; articulating
an articulable joint; and articulating the end effector; and
wherein stabilizing the end effector comprises: stabilizing the
stabilizable rotatable disk at a desired rotational position;
stabilizing the finger operable lever at the desired rotational
position; stabilizing the translation of force transfer member
portions at a desired translational position; stabilizing the
articulable joint at a desired angle of articulation; and
stabilizing the end effector at the desired angle of articulation,
wherein the stabilizable articulation actuator comprises: a
rotationally stabilizable disk; the finger operable lever rotating
the rotationally stabilizable disk, the lever comprising two
opposing arms, each arm of the lever connected to one of the at
least two force transfer member portions, the lever configured such
that its rotation moves a first transfer member portion in a
proximal direction and a second member portion in a distal
direction, wherein the stabilizable articulation actuator further
comprises a force member tensioning mechanism associated with the
rotatable finger-operable lever, the force member tensioning
mechanism configured to apply tension to the at least two force
transfer members, and wherein the force member tensioning mechanism
comprises a spring plate comprising two opposing arms, at least one
of the at least two force transfer member portions being threaded
through each arm of the rotatable finger-operable lever, through
the spring plate, and terminating proximal to the spring plate.
Description
INCORPORATION BY REFERENCE
All publications and patent applications mentioned in this
specification are herein incorporated by reference to the same
extent as if each individual publication or patent application was
specifically and individually indicated to be so incorporated by
reference.
FIELD OF THE INVENTION
The technology relates to medical devices for use during
laparoscopic procedures. More particularly, the technology relates
to an electrosurgical instrument with an articulable joint operable
to articulate an end effector.
BACKGROUND OF THE INVENTION
Biopolar electrosurgical instruments apply radiofrequency (RF)
energy to a surgical site to cut, ablate, or coagulate tissue. A
particular application of these electrosurgical effects is to seal
blood vessels or tissue sheets. A typical instrument takes the form
of a pair of opposing jaws or forceps, with one or more electrodes
on each jaw tip. In an electrosurgical procedure, the electrodes
are placed in close proximity to each other as the jaws are closed
on a target site such that the path of alternating current between
the two electrodes passes through tissue within the target site.
The mechanical force exerted by the jaws and the electrical current
combine to create the desired surgical effect. By controlling the
level of mechanical and electrical parameters, such as the pressure
applied by the jaws, the gap distance between electrodes, and the
voltage, current, frequency, and duration of the electrosurgical
energy applied to the tissue, the surgeon can coagulate, cauterize,
or seal tissue toward a therapeutic end.
Electrosurgical procedures can be performed in an open environment,
through conventional incisions, or they may be performed
laparoscopically, through small incisions, typically 0.5 cm-1.5 cm
in length. A laparoscopic procedure may include the use of a
telescopic rod lens system that is connected to a video camera and
to a fiber optic cable system that conveys light from a cold light
source to illuminate the operative field. The laparoscope is
typically inserted into a port in the body through a 5 mm or 10 mm
cannula to view the operative field. Surgery is performed during a
laparoscopic procedure with any of various tools that are typically
arranged at the distal end of a shaft and are operable by
manipulation of a handle or other actuator positioned at the
proximal end of the shaft.
The laparoscopic operating environment is very constrained
spatially; improvements with regard to the manipulatability of
laparoscopic devices by surgeons, or more particularly,
improvements in the range of motion that end effectors for
electrosurgical device can achieve would be advantageous in the
field.
SUMMARY OF THE INVENTION
Embodiments of the technology provided herein include an
articulable electrosurgical instrument and methods of performing
electrosurgery with an instrument having an articulating
capability. Embodiments of the electrosurgical instrument include
an elongated shaft having an end effector associated with a distal
end thereof and a handle associated with a proximal end thereof,
the end effector being able to deliver radiofrequency energy to a
target tissue site. In typical embodiments of the instrument, the
end effector may take the form of forceps or a set of jaws,
including a first jaw (a lower jaw, for example) and a second jaw
(a lower jaw, for example). The set of jaws is configured to grasp
target tissue and to deliver energy, such as radiofrequency energy.
In some of these instruments, the set of jaws is particularly
adapted to seal tissue by the application of radiofrequency energy,
and then to cut through the sealed tissue portion with a blade.
Embodiments of the instrument may further include an articulable
joint positioned between the shaft and the end effector; the joint
is configured to articulate the end effector angularly within an
arc of articulation, the articulable joint including at least one
pivotable link or flexible element, or alternatively, a set of one
of more interconnected pivotable links, disks, or flexing elements.
The instrument may further include a stabilizable articulation
actuator disposed proximal to the articulable joint. Some
embodiments of the instrument may include a shaft rotator or shaft
rotating actuator. The shaft rotator may be disposed proximal to
the articulable joint, may be disposed generally at a position
along a proximal portion of the shaft, and may be associated with
the handle portion of the device. In particular embodiments, the
stabilizable articulation actuator may be included within or in
association with a shaft rotator. The shaft rotator, itself, is
configured to rotate the shaft with respect to the handle, and by
virtue of rotation of the shaft, the end effector is also rotated.
Advantages of the stabilizable articulation actuator include
permitting a surgeon to put lateral forces on the end effector,
such as when using the end effector to retract tissue, without
having to manually operate a knob or other device to lock and later
unlock the angular orientation of the end effector. The
stabilizable articulation actuator can allow the surgeon to easily
move between different articulation angles without a separate
locking action, yet the angular orientation of the end effector may
be advantageously stabilized in the chosen articulation angle.
The instrument may further include at least two force transfer
members or member portions for translating rotational movement of
the actuator mechanism into articulating movement of the end
effector. The force transfer member are operably connected at their
proximal end to the articulation actuator, and operably connected
at their distal end through the articulable joint to a proximal
portion of the end effector, thereby allowing rotational movement
of the articulation actuator to be translated into articulating
movement of the end effector. Force transfer members may be of any
suitable form, such as wires, cables, rods, strips, or portions
thereof that can transfer tension and/or compression forces.
Embodiments of the instrument described herein, and examples of
embodiments shown in figures will refer to or depict cables, but it
should be understood that any suitable force transfer member is
included within the scope of the disclosure. The stabilizable
articulation actuator may be configured to stabilize the
articulable joint at an angle by stabilizing the force transfer
cables, the stabilized angle of the articulable joint being one of
a set of angles spaced apart at intervals within the arc of joint
articulation.
In some embodiments of the instrument, a stabilizable articulation
actuator includes a rotationally stabilizable disk seated in a
well, and a finger-operable lever configured to rotate a
rotationally stabilizable disk to stable position. The
finger-operable lever stabilizes the articulable joint in an
articulated position by way of transferring force from the actuator
through the force transfer cables to the articulable joint. In some
embodiments, the stabilizable articulation actuator is mounted
orthogonally or transverse to a central longitudinal axis of the
instrument, as represented, for example, by the shaft. Thus, in
these embodiments, the planes within the rotationally stabilizable
disk and the finger operable lever rotate are orthogonal or
transverse to the central longitudinal axis of the instrument.
Typical embodiments of the finger-operable lever include two
opposing arms, each arm of the lever being connected to a force
transfer cable, the lever is configured such that its rotation
moves a first transfer cable in a distal direction, thereby
applying tension to the first transfer cable, and a second cable in
a proximal direction, the second cable thereby being relieved of
tension.
In some embodiments of the instrument, the rotationally
stabilizable disk includes at least one spring portion biased
circumferentially outwardly against a wall of the circular well, a
circumferentially peripheral edge of the spring comprising one or
more teeth, the wall of the circular well comprising one or more
detents, the one or more teeth and the one or more detents
configured to be mutually engageable. A rotational configuration in
which teeth and detents are so engaged represents a stable position
of the articulation actuator. In some embodiments, the rotationally
stabilizable disk comprises two or more spring portions biased
circumferentially outwardly against a wall of the circular well,
the spring portions being distributed at equidistant intervals on
the circumferential periphery. In some embodiments, the
distribution of spring portions provides a circumferentially
balanced distribution of forces impinging on the stabilizable disk.
This balance of impinging centripetal forces advantageously
supports a smooth rotation of the disc about its center.
In some embodiments, the rotationally stabilizable disk and the
well in which it sits are adapted to stabilize rotation of the disk
at any one position of a set of stable positions spaced apart at
intervals within an arc of disk rotation. In some of these
embodiments, the arc of rotation of the rotationally stabilizable
disk encompasses about 90 degrees, including about 45 degrees in
either direction from a neutral position wherein the finger
operable lever is orthogonal to the shaft. The set of stable
positions are typically spaced apart at regular intervals within
the arc of rotation, such as set positions spaced apart at about 15
degrees. Typically, one of the stable positions is a neutral
position, wherein the finger operable lever is orthogonal to the
shaft. In general, articulating aspects of the articulable joint
correspond to rotational aspects of the rotationally stabilizable
disk. Thus, in some embodiments, the arc of articulation of the
articulable joint substantially corresponds to the arc of rotation
of the rotationally stabilizable disk. And, in some embodiments,
the articulable joint is adapted to stabilize at a set of stable
positions spaced apart at intervals that substantially correspond
to the stable positions of the rotationally stabilizable disk.
In some embodiments, the rotationally stabilizable disk and the
well in which it sits are configured such that the disk can be
stabilized at a position by a level of resistance to rotation of
the disk that can be overcome by application of torque to the
finger operable lever. In another aspect, the rotationally
stabilizable disk and the well in which it sits are configured such
that rotation of the disk through a stable position requires
applying a torque to the mechanism via the finger operable lever
that is greater than the torque required to rotate the disk through
portions of the arc between the stable angle positions. For
example, the torque required to rotate the rotationally
stabilizable disk with the finger operable lever through a stable
position may be in the range of about 2 to about 10 lbs. And for
example, the torque required to rotate the rotationally
stabilizable disk with the finger operable lever through portions
of the arc of rotation between the stable positions may be less
than about 2 lbs.
In some of these embodiments of the instrument, the stabilizable
articulation actuator may further include a cable tensioning
mechanism proximal to the rotatable finger-operable lever. One
example of a cable tensioning mechanism includes a spring plate as
described further below and depicted herein. Embodiments of the
spring plate include two opposing arms, one of the at least two
force transfer cables is threaded through each aim of the rotatable
finger-operable lever, through the spring plate, and then
terminating proximal to the spring plate. As noted above, the force
cables or cables move in opposite longitudinal directions as they
drive articulating movement of the end effector, one moving
distally and the other proximally. The spring plate is configured
to maintain tension on the force transfer cable that is moved in a
distal direction; absent the force provided by the spring, the
distal-moving force cable could accumulate a problematic degree of
slack. In some embodiments of the spring plate, each arm of the
spring plate includes a circumferentially outward-facing open slot
through which one of the force transfer cables is threaded.
Further, each arm of the spring plate may include a
circumferentially inward-facing open slot configured to engage a
spring plate retention tab.
In some of these embodiments of the instrument, each arm of the
finger operable lever includes a spring plate retention tab on a
distal facing surface of the lever, and the spring plate comprises
two opposing circumferentially inward facing slots. The tabs and
the inward facing slots are configured to mutually engage in such a
way so as to stabilize the spring plate against lateral slippage
when the finger operable lever is in a rotated position.
In some embodiments, the articulation actuator is further
configured to stabilize the end effector at a stable angle, the
stable angle of the end effector being any one of a set of angles
spaced apart at intervals within the arc of end effector
articulation. In some embodiments of the electrosurgical
instrument, the end effector is a set of forceps or jaws comprising
a first jaw and a second jaw. The first and second jaw may also be
referenced by terms such as an upper jaw and a lower jaw.
Typically, the set of jaws includes a plurality of bipolar
electrodes configured to receive energy from an energy source and
to deliver the energy to the target site.
In some embodiments of the electrosurgical instrument, the
articulable joint includes one or more pivotable links intervening
between a distal end of the elongated shaft and a proximal end and
the end effector. Some embodiments of the articulable joint include
two or more interconnected pivotable links. The property of having,
for example, one or more intervening pivotable links may also be
understood as the articulable joint as whole having two or more
intervertebral spaces within which pivoting may occur, or as the
articulable joint as whole having two or more interconnected sites
of pivoting articulation. In a typical configuration,
interconnected links of the articulable joint, as well as the
distal end of the shaft and the proximal end of the end effector,
include ball-like or cylindrical projections engageable in
complementary grooves.
In various embodiments, the articulable joint is configured to
pivot the end effector within an arc of about 90 degrees, the arc
including about 45 degrees in either direction from a neutral
position. In general, the angle of articulation is considered to be
the angle of a line tangent to the distal end of the articulable
joint with respect to a line corresponding to the central
longitudinal axis of the shaft. By virtue of the rotational
stabilizing mechanism and by way of the operation of the force
transfer cables, the articulable joint is stabilizable at a set of
angles spaced apart at intervals within the arc of about 90
degrees. The set of angles that are spaced apart at intervals
within the arc of rotation includes set angles spaced apart at
about 15 degrees. Typically, one of the stabilized angles is a
neutral angle, set at zero degrees with respect to the central
longitudinal axis of the shaft. Finally, in some embodiments of the
instrument, the articulable joint is adapted to be stabilizable at
a desired angle of articulation.
Embodiments of the articulable joint and its distal connection with
the end effector and its proximal connection to the shaft are
configured such that various operational aspects of the end
effector of the instrument are unaffected by the articulated
position of the end effector. Thus, for example, the operation of
opening and closing of the jaws, and the force that can be applied
by through the jaws when closing, are both independent of the
articulated position of the jaws. Similarly, movement of the blade
occurs and all electrosurgical performance capabilities are
unaffected by the articulated position of the jaws.
In some embodiments, an instrument with a set of jaws may further
include a blade and a blade drive member collectively configured to
be able to separate tissue at a target site into two portions when
the tissue is being grasped by the set of jaws. The blade may be
configured to reside in a home position distal to the articulable
joint, and to be able to move distally within the set of jaws. The
blade-driving member is typically disposed through the articulable
joint, and operable through the joint in any position of
articulation. The blade driving member may be configured as a push
and pull mechanism; and an actuator configured to control the
distal advancement of the blade and the proximal retreat for the
blade may reside in the handle of the instrument.
Some embodiments of the electrosurgical instrument take a form that
does not necessarily include a handle or a shaft; instead, for
example, the jaws may be mounted on any suitable base. Embodiments
such as these, could, for example, be incorporated into a robotic
apparatus. These embodiments include a set of jaws associated with
a base, the set of jaws enabled to deliver radiofrequency energy to
a target site, an articulable joint positioned distal to the base,
a stabilizable articulation actuator disposed in association with
the base, an articulable joint positioned between the base and the
set of jaws; and at least two force transfer cables for translating
rotational movement of the articulation actuator into articulating
movement of the set of jaws. In these embodiments, the articulable
joint is configured to articulate the set of jaws angularly within
an arc of articulation, and the articulable joint has least one
pivotable link positioned between a distal end of the shaft and a
proximal end of the set of jaws. In typical embodiments, the force
transfer cables are operably connected at their proximal end to the
articulation actuator, and operably connected at their distal end
through the articulable joint to a proximal portion of the set of
jaws. In some of these embodiments, the stabilizable articulation
actuator is configured to stabilize the articulable joint at a
stable angle by stabilizing the force transfer cables. The stable
angle of the articulable joint may be any one of a set of angles
spaced apart at intervals within the arc of joint articulation.
Embodiments of the provided technology also include a method of
electrosurgical tissue sealing that includes moving a set of
electrosurgical jaws into the proximity of a target tissue site.
The jaws are positioned on a distal end of an articulable joint;
the articulable joint is positioned distal to a shaft of an
electrosurgical device. Embodiments of the method may include
rotating a stabilizable articulation actuator with a finger
operable lever. The method may further include articulating the jaw
set with the articulable joint in order to position a distal end of
the jaws into a desired angle or position of articulation such that
when the jaws are closed they grasp the target tissue site. The
method may then further include grasping the target tissue site
with the jaws. The method may then further include delivering
radiofrequency energy to the target tissue site from the jaws to
seal the target tissue site. The method may still further include
cutting through the newly sealed tissue site.
Embodiments of the method may include moving a set of jaws of an
electrosurgical instrument into proximity of a target tissue site,
the set of jaws being positioned on the instrument distal to an
articulable joint. The method may further include rotating a
stabilizable articulation actuator with a finger operable lever to
a desired rotational position, and thereby articulating the
articulable joint to a desired angle of articulation. The method
may further include stabilizing the stabilizable articulation
actuator in the desired rotational position, and thereby
stabilizing the articulable joint in the desired angle of
articulation.
The angular articulation of the articulable joint at an angle may
be understood to refer to an angle associated with a line tangent
to the distal end of the articulable joint with respect to the
central longitudinal axis of the shaft of the instrument.
Similarly, the angle of articulation associated with an end
effector, such as a set of jaws, refers to an angle of a line
associated with the common longitudinal axis of the jaws (as taken
when the jaws are closed) with as compared to a line corresponding
to the central longitudinal axis of a the shaft of the instrument.
In general, a desired angle of articulation of either the
articulable joint or an end effector distal to the joint refers to
an angle such that the jaws are closed, they will close around and
grasp the tissue targeted for electrosurgical engagement.
In some embodiments, rotating the stabilizable articulation
actuator occurs by way of rotating a rotationally stabilizable
disk, and, wherein stabilizing the stabilizable articulation
actuator occurs by way of stabilizing a rotationally stabilizable
disk.
Some embodiments of the method may further include articulating the
set of jaws in accordance with rotating the stabilizable
articulation actuator. And in some embodiments, the method may
further include stabilizing the set of jaws in a desired angle of
articulation in accordance with stabilizing the articulable joint
in the desired angle of articulation.
Some embodiments of the method including rotating a finger-operable
lever associated with the articulation actuator, thereby rotating
the rotationally stabilizable disk within the actuator. Some of
these embodiments may further include tensioning the force transfer
cables with a tensioning mechanism associated with the
finger-operable lever. The method may further include driving the
movement of at least two force transfer cables in accordance with
rotating the rotationally stabilizable disk. In such embodiments,
driving the movement of the at least two force transfer cables
includes applying tension from the proximal end of one of the force
transfer cables and relieving tension from the other force transfer
cable, the proximal ends of the force cables being operably engaged
to the stabilizable articulation actuator.
In typical embodiments of the method, articulating either the
articulable joint or the end effector refers to a capability of
pivoting within an arc of about 45 degrees in either direction from
a centerline within a plane, thereby providing a total pivotable
range of about 90 degrees. In some embodiments of the instrument,
the articulable joint includes one or more pivotable links
positioned between a distal end of a shaft of the instrument and a
proximal end of the jaws. In these embodiments, articulating the
articulable joint may include pivoting the one or more pivotable
links with respect to each other or with respect to the distal end
of the shaft or the proximal end of the jaws.
Moving the set of jaws into proximity of a target tissue site may
occur in several aspects, including a step of advancing the set of
jaws the jaws through a trocar into a laparoscopic operating space,
and a step of rotating the jaws. Rotation, in this context refers
to rotating the jaws about their central common longitudinal axis,
such axis defined by the jaws when they are in a closed position,
or as represented by a common base portion of the jaws.
In some embodiments, rotating the set of jaws around their central
longitudinal axis includes rotating from a neutral position within
a range of up to about 180 degrees on either side of the neutral
position. In various embodiments, wherein rotating the set of jaws
around their central longitudinal axis of the set of jaws occurs by
way of rotating a shaft of the electrosurgical instrument, which in
turn, may occur by rotating a shaft rotating actuator of the
instrument.
In various embodiments of the method, stabilizing the set of jaws
in the desired angle of articulation is a step performed in
conjunction with or simultaneously with articulating the
articulable joint to its desired angle of articulation. Stabilizing
the jaws at a particular angle of articulation, such as a desirable
angle for grasping target tissue, may occur in close or causal
relation to stabilizing the articulable joint, stabilizing force
transfer members that control the angle of the articulable joint,
and stabilizing a rotationally stabilizable disk with the
stabilizable articulation actuator.
More particularly, stabilizing the stabilizable articulation
actuator in the desired position may include engaging teeth on the
periphery of a rotationally stabilizable disk with complementary
detents on an inner aspect of a well in which the rotatable disc is
housed. In another aspect, stabilizing the stabilizable
articulation actuator may include rotating a lever of a
stabilizable articulation actuator through a portion of an arc of
relatively low rotational resistance until the lever encounters a
position of relatively high rotational resistance, such position
being a position of articulated stability. In yet another aspect,
wherein stabilizing the stabilizable articulation actuator may
include rotating a lever of a stabilizable actuator through a
portion of an arc that may include one or more regions of moderate
rotational resistance and one or more regions of high rotational
resistance, until the lever encounters a particular position of
high rotational resistance wherein the jaws are in a desired
position of articulation. In the context of this latter embodiment,
rotating the lever through a region a low rotational resistance may
include applying a torque to the lever in the range of less than
about 2 lb. inches, and rotating the lever through a region a high
rotational resistance may include applying a torque to the lever in
the range of about 2 to about 15 lb. inches.
Embodiments of the method may include further steps, such as
grasping the target tissue with the set of jaws, and such as
opening the set of jaws prior to the grasping step. The method may
further specifically include delivering radiofrequency energy to
the target tissue site from the set of jaws after the jaws have
grasped the target tissue site. Some embodiments of the method may
include multiple electrosurgical treatments once the jaws have
entered the laparoscopic operating space. As such, the method may
further include moving the set of jaws to proximity of a second
site while maintaining the set of jaws at the previous angle of
articulation, and repeating the grasping step and the delivering
energy step, these steps being directed toward the second target
site.
In another aspect, the disclosed method of articulating and
stabilizing an end effector of an electrosurgical instrument may be
understood as a series of articulating steps that can be combined
with a series of stabilizing steps to achieve articulation and
stabilization of an end effector at a desired articulated angle.
Accordingly, articulating the end effector may include rotating a
finger operable lever, rotating a stabilizable rotatable disk,
moving force transfer cables translationally, articulating an
articulable joint, and articulating the end effector. Stabilizing
the end effector may include stabilizing the stabilizable rotatable
disk at a desired rotational position, stabilizing the finger
operable lever at the desired rotational position, stabilizing the
translation of force transfer cables at a desired translational
position, stabilizing the articulable joint at a desired angle of
articulation, and stabilizing the end effector at the desired angle
of articulation. By embodiments of this method, rotating the finger
operable lever may result in rotating the stabilizable disk through
one or more regions of relatively low rotational resistance and
relatively high rotational resistance. Further by this method,
stabilizing the end effector may include stopping rotation of the
stabilizable disk at a position of relatively high rotational
resistance.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective diagram showing an articulable joint of an
articulable electrosurgical instrument.
FIG. 2A is a plan view showing an articulable joint of an
articulable electrosurgical instrument.
FIG. 2B is a plan view showing an articulable joint of an
articulable electrosurgical instrument wherein an articulable joint
comprises one link intervening between the shaft and the jaws.
FIG. 3 is a schematic view showing a top cutaway of a joint
articulation control mechanism of an articulable electrosurgical
instrument.
FIG. 4 is a perspective schematic view showing an articulable
electrosurgical instrument.
FIG. 5 is another perspective view of an articulable
electrosurgical instrument.
FIG. 6 is a perspective schematic view of an indexing mechanism for
an articulable electrosurgical instrument.
FIG. 7 is a perspective schematic view of a detent mechanism for an
articulable electrosurgical instrument.
FIG. 8 is a perspective schematic view of a detent and indexing
mechanism for an articulable electrosurgical instrument.
FIG. 9 is a plan schematic view of a step ball detent mechanism for
an articulable electrosurgical instrument.
FIG. 10 is a perspective schematic view of the step ball detent
mechanism for an articulable electrosurgical instrument.
FIG. 11 is a second perspective schematic view of the step ball
detent mechanism for an articulable electrosurgical instrument.
FIG. 12 is a perspective schematic view of a push lock mechanism
for an articulation control in an articulable electrosurgical
instrument.
FIG. 13 is a phantom perspective schematic view of the push lock
mechanism for an articulation control mechanism in an articulable
electrosurgical instrument.
FIG. 14 is a perspective schematic view of a grab knob for the push
lock mechanism in an articulation control for an articulable
electrosurgical instrument.
FIG. 15 is a perspective, partially cutaway view of an articulable
electrosurgical instrument, showing a drive member.
FIG. 16 is a perspective view of a drive assembly for a blade
within an articulable electrosurgical device.
FIG. 17 is a perspective view of an embodiment of an articulable
electrosurgical device, with an indexing mechanism proximal to the
shaft, and an articulable joint positioned distal to the shaft and
proximal to a set of jaws, the articulable joint in an articulating
position. Other views of aspects of this embodiment are shown in
FIGS. 18-28.
FIG. 18 is a perspective view a proximal portion of an articulable
electrosurgical device depicted with a shaft rotator shown
transparently, an embodiment of a stabilizable articulation
actuator contained therein.
FIG. 19 is a top view, partially exposed, of a shaft rotator
portion of an articulable electrosurgical device; an embodiment of
a stabilizable articulation actuator contained therein is shown
with a finger lever in a neutral position.
FIG. 20 is a top view, partially exposed, of a shaft rotator
portion of an articulable electrosurgical device; an embodiment of
a stabilizable articulation actuator contained therein is shown
with a finger lever in a partially rotated position.
FIG. 21 is a top view of an isolated portion of a stabilizable
articulation actuator showing a rotationally stabilizable disk, its
finger operable lever, and force transfer cables.
FIG. 22 is a top view with a slight proximal-looking angle of an
exposed base portion of a stabilizable articulation actuator,
showing the receptacle portion into which the rotationally
stabilizable disk may be seated.
FIG. 23 is an exploded perspective view of a stabilizable
articulation actuator, showing a receptacle portion into which the
rotationally stabilizable disk is seated, an indexing disk, a
finger operable lever to rotate the disk, and a spring plate
positioned distal to the finger operable lever.
FIG. 24 is a perspective view of an indexing disk constructed; this
embodiment comprises two outwardly biased spring portions.
FIG. 25 is a perspective view of an isolated portion of aspects of
a stabilizable articulation actuator that includes a finger
operable lever, a spring plate, and actuating wires that
communicate with the distally positioned articulable joint.
FIG. 26 is a perspective view of a spring plate portion of a
stabilizable articulation actuator.
FIG. 27 is a side view of a spring plate aligned against a finger
operable lever.
FIG. 28 is a schematic diagram of an aspect of a method for
articulating an articulable joint and stabilizing it at a desired
angle of articulation.
DETAILED DESCRIPTION OF THE INVENTION
Aspects of the technology provided herein include a method and
apparatus for articulating the joint of an articulable
electrosurgical instrument that would typically used in a
laparoscopic environment, but is also suitable for use in an open
operating environment. Examples of electrosurgical devices that
could incorporate the articulable features as described herein,
include devices as described in the following, all of which are
incorporated herein, in their entirety: U.S. Pat. No. 7,862,565
entitled "METHOD FOR TISSUE CAUTERIZATION issued on Jan. 4, 2011;
U.S. Pat. No. 7,803,156 entitled "METHOD AND APPARATUS FOR SURGICAL
ELECTROCAUTERY" issued on Sep. 28, 2010; U.S. Pat. No. 7,794,461
entitled "METHOD AND APPARATUS FOR SURGICAL ELECTROCAUTERY" issued
on Sep. 14, 2010; U.S. application Ser. No. 11/743,579 entitled
"SURGICAL TOOL" filed on May 2, 2007, published on Jul. 17, 2008 as
U.S. Publication No. 2008/0172052A1; U.S. application Ser. No.
11/382,652 entitled "APPARATUS FOR TISSUE CAUTERIZATION" filed on
May 10, 2006, published on Nov. 16, 2006 as U.S. Publication No.
2006/0259034A1; U.S. application Ser. No. 11/671,891 entitled
"ELECTROCAUTERY METHOD AND APPARATUS" filed on Feb. 6, 2007,
published on Jun. 7, 2007 as U.S. Publication No. 2007/0129726A1;
U.S. application Ser. No. 12/121,734 entitled "ELECTROCAUTERY
METHOD AND APPARATUS" filed on May 15, 2008, published on Sep. 11,
2008 as U.S. Publication No. 2008/0221565A1; U.S. application Ser.
No. 12/062,516 entitled "ELECTROCAUTERY METHOD AND APPARATUS" filed
on Apr. 4, 2008, published on Sep. 18, 2008 as U.S. Publication No.
2008/0228179A1; U.S. application Ser. No. 12/410,322 entitled
"ELECTROCAUTERY METHOD AND APPARATUS" filed on Mar. 24, 2009,
published on Jul. 16, 2009 as U.S. Publication No. 2009/0182323A1;
U.S. application Ser. No. 11/671,911 entitled "ELECTROCAUTERY
METHOD AND APPARATUS" filed on Feb. 6, 2007, published on Aug. 9,
2007 as U.S. Publication No. 2007/0185482A1; U.S. application Ser.
No. 12/748,229 entitled "IMPEDANCE MEDIATED POWER DELIVERY FOR
ELECTROSURGERY" filed on Mar. 26, 2010, and U.S. application Ser.
No. 12/907,646 entitled "IMPEDANCE MEDIATED CONTROL OF POWER
DELIVERY FOR ELECTROSURGERY" filed on Oct. 19, 2010.
The presently described medical instrument, a bipolar
electrosurgical device by way of example, may be configured to seal
tissue and/or to cut tissue, and has an end effector that can be
articulated through the operation of an articulable joint.
Embodiments of the instrument typically have a set of opposing jaws
that can be articulated up to an angle of about 45 degrees, both to
the left and the right from a centerline defined by the central
longitudinal axis of the shaft of the instrument, for a total
articulation range of about 90 degrees. Aspects of the technology
also provide a proper bend radius and support for a jaw actuation
member and a cutter-driving member. In some embodiments, a bendable
support for the drive includes tightly wound coil springs.
Some embodiments of the technology further include a mechanism and
a method to control the degree of articulation with an actuator
disposed at the handle of the articulable electrosurgical
instrument. Embodiments of the technology may further include a
locking mechanism, or more generally, a stabilizable articulation
actuator, to prevent motion of the articulable joint while an
operator, typically a surgeon, performs electrosurgical procedures
with the device. Embodiments of the locking mechanism also include
an indexing feature with which a surgeon operator can index and
choose the necessary amount of angle between preset angles.
Some embodiments of the technology include, in the form of a
distally positioned articulable joint or wrist, a set of pivotal
vertebra, links, hinges, or flexible elements that are
interconnected by pins, or by a snap fit, or by tension applied by
a force transfer member. Each vertebra is adapted to pivot in
relation to the longitudinal axis of the shaft and jaw set, thus
allowing left and right articulation. The angle of articulation is
controlled by connecting or force-transfer members, such as wires
or cables, which are disposed along both sides of the articulable
joint. The connecting wires are proximally routed up the shaft and
connected with tension to a control mechanism at a device handle,
and function by transferring force from the handle to the
joint.
Embodiments of the links or vertebrae collectively form a proper
bend radius in embodiments of the distal articulable joint, a bend
radius that is sufficiently large that it allows for a force
transfer wire or cable to pass through the joint without kinking.
Further, in some embodiments, a tightly wound coil spring is housed
within the joint to route the wire. The tightly wound coil spring
provides additional support to the wire, such that when the wire is
moved back and forth, proximally or distally, it does not buckle or
kink.
Embodiments of the control mechanism at the handle include an
indexing disk and finger operable lever that receives the force
transfer cables or wires from the joint. The indexing disk is
pivotally mounted at the handle of the instrument, and the shape of
the control mechanism allows for concentric rotation about the
pivot so that the length-wise motion of the wires or cables along
the shaft can be controlled, based upon the distance from the pivot
to the attachment point of the wires or cables. The distances that
the force transfer cables move controls the articulation position
or angle; these distances are available as preset options according
to the geometry of the joint and the indexing disk and its
lever.
Several embodiments of the technology have a stabilizable
articulation actuator include indexing or locking features. This
mechanism, in its various embodiments can specify particular angles
of articulation, and can stabilize the end effector distal to the
joint at particular angles. The stabilized or lockable angles are
located at spaced apart intervals within the arc of articulating
rotation. In a first embodiment, a spring steel member is formed
into a geometry that deflects when a force is applied, as with a
leaf spring. An example of this embodiment, with a spring steel
member is shown in FIG. 6; other aspects of the locking and
indexing mechanism are shown in FIGS. 7 and 8. The leaf spring is
housed within a circular carrier, with only the deflectable portion
of the spring accessible and protruding from a circular carrier. A
rotating member with a circular portion removed from its pivot area
fits over the circular carrier. A tooth pattern is also removed
from along the inner diameter of the circular portion of the
rotating member. The rotating member includes arms extending from
its center body to which the cable or wires are attached. The
leaf-like spring protrudes into the indentations created by the
tooth pattern. The distance between the teeth and the distance from
the attachment point of the cable or wires to the pivot point
control the articulation angle.
In a second embodiment of a stabilizable articulation actuator with
indexing or locking features, a spring plunger is mounted within a
circular carrier opposite a step ball. The spring plunger mates
with the indents created by the tooth pattern. Examples of this
particular embodiment of a stabilizable articulation actuator are
shown in FIGS. 9 and 10.
In a third embodiment of a stabilizable articulation actuator with
indexing or locking features, the rotating member described above
does not have arms extending from its center body. A wing is
mounted on top of the rotating member. The wing is then manipulated
to control the rotation around the circular carrier.
In a fourth embodiment of a stabilizable articulation actuator with
indexing or locking features, a flexible plastic hinge, also known
as a living hinge, is mounted near the handle. The living plastic
hinge uses a V-shape that fits within a slot of an external housing
that surrounds the living hinge. The tip of the V-shape protrudes
from each slot. There is a series of slots along the length of the
external housing. The housing engages with the cable and wires that
control articulation of the joint. The operator can adjust and lock
the joint articulation by first pressing down on the living hinge
to disengage the current locked position, then moving the external
housing from a proximal to a distal position or vice versa, which
then locks by re-engaging with the living hinge at any various
predetermined distances set by the slots. These distances determine
the angle at which the joint is articulated.
In a fifth embodiment of a stabilizable articulation actuator with
indexing or locking features, the rotating mechanism described
above rotates freely around the pivot. When an operator or surgeon
has determined the angle of articulation, an indexing pin mounted
on top of the pivot is depressed, which locks the joint angle and
the rotating mechanism, thus preventing any further movement of
both the rotating mechanism and joint. This can be accomplished
using a wedge-like design that is anchored within the pivot pin,
which in this embodiment is a tube. A minimum of a single slot is
designed into the pivot pin. When the button is depressed, the
inherent spring properties of the button flare from the slot. The
flaring material uses friction to prevent movement of the rotating
mechanism. The button itself remains in place due to a wedge design
at the top. An example of this particular embodiment of a locking
and indexing mechanism is shown in FIGS. 12, 13, and 14, as
described further below.
In a sixth embodiment of the disclosed technology, a stabilizable
articulation actuator of the electrosurgical instrument includes an
indexing or rotational position stabilizing disk with spring piece
arms that have teeth that can engage complementary detents in a
receptacle or well within which the disk is rotatably seated. This
particular embodiment of an articulation actuator includes a
non-locking mechanism. Articulation angles of an articulation joint
are not locked into place, but are, instead stabilized by a
relatively high level of rotational resistance in the actuator that
can nevertheless be overridden by a level of torque easily applied
to a finger operable lever. Examples and views of this sixth
embodiment are shown in FIGS. 17-28, and described further
below.
In the description of the disclosed technology and as shown in
FIGS. 1-28, embodiments of the stabilizable articulation actuator
may be included within or in association with a shaft rotator
portion of an electrosurgical instrument for design considerations.
However, in other embodiments of the disclosed technology, these
two functional actuators could be positioned in physically separate
locations. Further, other embodiments of the disclosed technology,
including a stabilizable articulation actuator and an operably
connected articulable joint, may be included in a broad range of
devices, such as those that do not deliver radiofrequency energy,
or in devices that do not have a shaft, that do not have a handle,
or which have neither a shaft nor a handle.
Further to the foregoing description, a more detailed explanation
is now provided in connection with examples of the technology as
depicted FIGS. 1-28. Many electrosurgical features of embodiments
of the device, such as bipolar electrode pairs, are not shown in
order to focus on features that provide articulability to the
device. Details of electrosurgical features may be found in the
patent applications identified above.
FIG. 1 is a perspective view of a distal portion of an embodiment
of an articulable electrosurgical device according to aspects of
the technology; it shows a distal portion of the main shaft 24 of
the electrosurgical device and an end effector, in this example, a
jaw assembly 25 which includes lower jaw 11 and an upper jaw 13. In
a more general aspect, jaw assembly may be described as having a
having a first jaw 11 and a second jaw 13. Inasmuch as some
embodiments of the device have a rotatable shaft and thus, a
rotatable set of jaws, the terms upper and lower may have no
absolute significance, but they may be useful in describing the
jaws as they appear in figures, or as they may be so designated by
marking or by convention. In this embodiment, the upper jaw is
pivotable away from and toward the lower jaw about a pivot point
17, which typically includes a pin or axle. In other embodiments of
the technology, the lower jaw may be pivotable as well, but in this
particular embodiment, the lower jaw is fixed. Pivoting of the
upper jaw is accomplished by transmitting tension to a jaw
activation pin 18, which is moveable in an activation slot 19.
Typically, tension is applied via a cable attached to the jaw
activation pin. In this example of an end effector, the jaw set or
assembly 25 is configured for such laparoscopic procedures as
electrosurgical tissue sealing and cutting. Accordingly, as shown
in the bottom jaw 11, a distal electrode 12 is provided, embedded
in the plastic carrier 15. A second, proximal electrode 16 is also
shown. A cutting groove 14 is shown for receiving a blade (not
visible) during a tissue separating procedure that occurs in
conjunction with tissue sealing. Also visible in FIG. 1 and FIG. 2
is an articulable wrist or joint 22, as described further
below.
During laparoscopic electrosurgical procedures, it is desirable to
be able to position the jaws of the device from left to right
within an arc of a plane of articulating freedom to achieve the
best angle of approach to a target tissue site; this capability is
provided by an articulable joint or joints 22 that includes one or
more articulation disks, links, or vertebrae 21. In this particular
embodiment of articulable joint 22, two pivotable links 21 are
shown intervening between the distal end of shaft 24 and the
proximal end of jaw assembly 25. Articulation is accomplished by
tensioning a pair of cables (described further below) that
terminate distally where they are soldered or crimped in a groove
at a cable termination point 20. FIG. 1 further shows a clamping
slot 23, which functions as a lock for an outside shaft tube or
clamping mechanism to hold the articulable joint 22 to the
tube.
FIG. 2A is a top or plan view of a distal portion of an embodiment
of an articulable electrosurgical device showing the jaws 25 and
shaft 24 disposed on opposite ends of an articulable joint 22. FIG.
2B is a plan view showing an articulable joint of an articulable
electrosurgical instrument wherein an articulable joint comprises
one link intervening between the shaft and the jaws. Embodiments of
the articulable joint include interconnected pivotable, hinged
links or disks; the disks 21 are articulated with one another and
include a series of ball-like or cylindrical-like projections 27
that are engaged in complementary grooves 28. The jaw assembly 25
of this embodiment shows a particular distal-most, proximally
directed ball-like projection 29 associated with the jaw assembly
25 that is engaged in a groove of an articulation link, and the
shaft 24 includes a distal-opening complementary groove 30 for
receiving a ball-like or cylindrically-shaped projection of an
articulating disk. In some embodiments, the articulation range of
the articulable joint is contained within an arc of a plane,
although a proximally disposed shaft rotator can rotate the end
effector, as a whole. Some embodiments of the articulable joint are
stabilizable at a desired angle of articulation, thereby also
stabilizing the end effector at a desired angle of articulation. A
short segment of a cable 31 is shown in FIGS. 2A and 2B as well;
the cable includes a coiled pipe sheath assembly and is used to
operate a slidable blade within the jaw. As noted above, the coiled
assembly allows the cable to bend with the articulation of the
device without kinking.
Embodiments of an articulable joint as provided herein include one
or more pivotable links intervening between the distal end of the
shaft and the proximal end of the end effector. An advantage
associated with a plurality of links, e.g., two or more intervening
articulable links, is that the plurality may provide an enhanced
articulation angle range, and enhanced resolution and stability of
articulated angles. An advantage of relatively few intervening
links, such as one link, relates to ease of manufacturing assembly
and lower cost. Examples of articulable joints that include one
intervening link are shown in FIG. 2B. Examples of articulable
joints that include two intervening links are shown in FIGS. 1 and
2A. An example of an articulable joint that includes three links is
shown in FIG. 15. An example of an articulable that joint includes
four links is shown in FIG. 17. Embodiments of an articulating
links such as these described and depicted are but an example of an
appropriate link configuration; other suitable link configurations
are known in the art and may be included as embodiments of the
technology.
FIG. 3 is a partially cutaway side schematic view of an embodiment
of an articulation control or actuation mechanism 32 for operating
the articulation joint. A joint articulation control member or
lever 33 is shown having two finger surfaces at opposite ends of
the control member; these finger surfaces allow a surgeon to pivot
the control member about a pivot point 35. Parallel pretensioned
control cables 34a/34b (comprising Nitinol or other suitable cable
materials) are attached to respective points on the control member.
This pivoting action of control member 33 respectively applies
tension to and draws tension from the pair of control cables
34a/34b. Operation of the joint articulation control causes one
cable of the paired cables to pull back on the jaw assembly 25
while the other cable releases tension, thus causing the jaw
assembly to move left or right, as desired.
FIG. 4 is a perspective view of a proximal portion of an
articulable electrosurgical device 10 according to aspects of the
technology showing a housing 43 having a handle 44 and a jaw
activation trigger 45 that operates a four-bar linkage or other
type of linkage 46 to transmit tension through the main shaft 24
and thereby operate the jaws to open and close them as desired. A
blade actuator member 42 is also shown, by which a blade may be
drawn through a cutting groove 14 (shown in FIG. 1). A shaft
rotator or end-effector rotational actuator 41 allows the shaft to
be rotated about a shaft access, while the joint articulation
control member 33 allows the joint mechanism to be operated. Note
in FIG. 4 that the joint articulation control mechanism 32 includes
a control slot 40 that both guides and limits the travel of the
joint articulation control member 33.
FIG. 5 is a perspective view of a proximal portion of an embodiment
of the articulable electrosurgical device 10 in which a shaft
rotator 51 is contained within a housing 57. This embodiment also
includes a blade actuator 52, a joint articulation control member
53, a handle 54, and a jaw activation trigger 55.
FIG. 6 is a perspective schematic view of an embodiment of a joint
actuation control mechanism of the articulable electrosurgical
device shown in FIG. 5; this embodiment of the control mechanism
includes an indexing capability. A base portion 66 of indexing the
indexing articulation control mechanism supports a ring projection
65 that, in turn, accommodates the control member 53. Tensioned
cables 34a/34b each have termination balls 64a/64b that serve as
cable stops. Cables 34a/34b are threaded through the control
actuator member 53 by way of respective grooves 63a/63b. An
indexing disk 97 includes a plurality of detents 62. A flat spring
61 is arranged to engage within the detents to provide a stop
mechanism to secure the jaws in a selected position by preventing
movement of the articulation control member 53, except when desired
by an operator of the device.
FIGS. 7 and 8 provide detailed views of various features of the
indexing articulation actuation mechanism shown in FIG. 6. FIG. 7
is a perspective schematic view of the base portion 66 of the
articulation control mechanism that shows a spring mechanism 61
sitting in a recess 70 of the ring-like projection 65. FIG. 8 is a
schematic perspective view of the articulation control member 53
showing the detents 62 in greater detail.
FIG. 9 provides a top view of an alternative embodiment of an
indexing articulation control or actuation mechanism 90 for an
articulable joint. A base portion 96 supports an articulation
control member 93 that includes a plurality of detents 92 formed in
a detent-indexing disk 97. The control member and detent-indexing
disk are rotatably mounted on a base structure 96. Operation of
control member 93 causes rotation of indexing disk 97 about a pivot
point 91, and consequent engagement of a step ball 95 into one of a
plurality of detents 92 within the indexing ring. A ball plunger
mechanism 94 circumferentially opposite the step ball 95 maintains
bias on the step ball. The indexing control member 93 includes a
pair of proximal attachment points 98a/98b for control cables that
extend distally to an articulable joint or wrist.
FIG. 10 is a perspective view of the index control mechanism for an
embodiment of an articulation actuation mechanism 90 (as seen in
top view in FIG. 9). FIG. 11 is a more horizontally oriented
perspective view of the control mechanism for the articulation
joint in an articulable electrosurgical device according to aspects
of the technology. The arrangement of the articulation control
member 93 in connection with the indexing ring 97 is shown, and in
particular shows the attachment there between a pair of pins
98a/98b. FIG. 11 also shows a pair of grooves 100a/100b for
receiving control cables (cables not shown in this view).
FIGS. 12-14 show a further embodiment of an indexing articulation
actuation mechanism that includes an indexing pin. FIG. 12 shows an
indexing pin 120 that is engaged in a slot 121. FIG. 13 is a
cutaway perspective phantom view showing the indexing pin 120
comprising a head portion 131 and a plurality of flared portions
130 which engage or disengage with a locking block 133.
Accordingly, this embodiment of the technology includes a jam lock
in which depression of the pin 120 jams the flared portion of the
pin 130 into the block 133 and thus prevents rotation of the
actuation control mechanism. FIG. 14 is a detailed view of the jam
mechanism showing the pin 120, head 131, and flares 130 in greater
detail.
FIGS. 15 and 16 depict aspects of an end effector drive member of
embodiments of an articulable electrosurgical device. An end
effector drive member, in general, drives a particular function
associated with the end effector. In this embodiment of an
electrosurgical device, the end effector is a set of jaws, and
accordingly, a drive member may control the opening and closing of
the jaws. FIG. 15 is a perspective, partially cutaway view of a
distal end effector portion of an articulable electrosurgical
device, showing a drive member according to aspects of the
technology. FIG. 15 shows the articulable joint 22 of the device,
while FIG. 16 shows a jaw-activating band 150, a closing pin 160,
and cutting blade 161, a distal portion of which extends back to
the handle of the instrument, where an actuator that advances and
retreats the blade resides. The operation of a drive member 150
that controls opening and closing of the jaws and the operation of
the blade by distally advancing and retreating are performed by
separate mechanisms, which operate independently.
The drive members may be made of a round wire (stainless steel or
Nitinol), using tightly wound coil springs for support. The drive
members may also be flat stainless steel bands 150, as shown in
FIGS. 15 and 16. Instead of the round wire that serves as a drive
member in some embodiments, this embodiment may include flat bands,
and may support the bands with aspects of the internal structure of
the links. Other embodiments may use flat polymer bands to provide
additional support. These bands may be formed from polymers such as
polytetrafluoroethylene (PTFE, Teflon.TM.) or fluorinated ethylene
propylene (FEP). The support structure may also include PTFE or FEP
shrink tubing over the blade and/or the jaw actuation band.
An embodiment of an articulable joint 22 is also shown in FIG. 15.
In this particular embodiment of articulable joint 22, three
pivotable links 21 are shown intervening between the distal end of
shaft 24 and the proximal end of jaw assembly 25.
FIGS. 17-28 provide views of a particular embodiment of an
articulable electrosurgical device with a stabilizable articulation
actuator and associated methods for its use, in accordance with the
sixth embodiment of the technology as noted above. In some of these
embodiments, the stabilizable articulation actuator is a
substantially non-locking mechanism in that rotational angles are
stabilized by virtue of the relative high resistance to rotation
required to move the mechanism out of the stable angle position, in
contrast to the relatively low resistance encountered during
rotation of the mechanism between the angles that represent stable
positions. In another aspect, it may be understood that moving
through the regions of relatively high rotational resistance is
part of the normal procedure by which a desired angle of
articulation is arrived at. Embodiments of the stabilizable
articulation actuator cooperate with the end effector, via cables,
in order to control and stabilize the articulation angle of the end
effector. Further details of the stabilizable articulation actuator
are provided in the context of describing FIG. 20, below.
The stabilizable articulation actuator includes a cable tensioning
mechanism 170 associated with the cross bar of a finger-operable
lever that enhances the articulating performance of the distal
articulable joint. The cable tensioning mechanism maintains a
tension on cables 34a/34b, and allows greater tolerance in
dimensions or manufacturing specification ranges of both proximal
and distal elements of the articulable mechanism, as well as the
length of cables, and further serves generally to retain or
stabilize these elements in a functional configuration. In some
embodiments, the cable tensioning mechanism 170 may comprise a
spring plate, as shown in FIGS. 19-21, 23, and 25-27.
FIG. 17 is a perspective view of an embodiment of an articulable
electrosurgical device 10, with a stabilizable articulation
actuator proximal to the shaft, and a distal articulable joint 22
positioned distal to the shaft 24 and proximal to an end effector
in the form of a set of jaws 25. The distal articulable joint 22 is
in an articulated position. The proximal portion of the device
includes a housing 143 that is contiguous with a handle portion 44.
The proximal portion further includes a jaw activation trigger 45
and a blade actuator member 42. The stabilizable articulation
actuator is not exposed in this figure; it is included within the
shaft rotator apparatus 141. In this embodiment, the end effector
25 can effect an articulation toward either side of a neutral
position, the articulation angle approaching a maximum of
approximately 45 degrees to either side of a neutral position. A
neutral position is one in which the central longitudinal axis of
the end effector is parallel to the central longitudinal axis of
the shaft of the electrosurgical instrument.
The angles of articulation of the jaws with respect to the shaft
are controlled by the stabilizable articulation actuator, and
reflect or approximate the angles determined by operation of a
lever of the stabilizable articulation actuator. Accordingly, the
set of jaws may pivot to either side of a neutral position within a
range of about 45 degrees, for a total pivotable range or arc of
rotation of about 90 degrees. Further, in a manner determined by
the stabilizable articulation actuator, the pivoting angles assumed
by the set of jaws are stabilizable at spaced apart angle
intervals. In some embodiments, these spaced apart angles occur at
15-degree intervals.
FIG. 18 is a perspective view a proximal portion of an articulable
electrosurgical device 10 depicted with a shaft rotator assembly
141 shown transparently; an embodiment of a stabilizable
articulation actuator 190 can be seen contained therein. Although
embodiments of the device depicted in this series of figures shows
the stabilizable articulation actuator included within a shaft
rotator assembly, the stabilizable articulation actuator, while
typically disposed at a position proximal to the shaft, it is not
necessarily housed within a shaft rotator assembly.
FIG. 19 is a top view, partially exposed, of a shaft rotator
portion 141 of an articulable electrosurgical device 10. An
embodiment of a stabilizable articulation actuator 190 is contained
therein, and a finger-operable lever is shown in a neutral
position. Such neutral position would hold the distal articulable
joint in a neutral or non-articulated position. The proximal
portions of tensioned articulating cables 34a/34b can be seen
threaded through a central bar portion 235 of finger operable lever
233 and a spring plate 170 proximal to the central bar. Details of
this latter arrangement are seen in figures that follow.
FIG. 20 is a partially exposed top view of a shaft rotator portion
of an articulable electrosurgical device. An embodiment of a
stabilizable articulation actuator is shown with a finger lever 235
in a partially rotated position. The scale of the drawing is
expanded over that of FIG. 19, which allows a more detailed view of
its features. Seen particularly well here are the teeth 165
disposed on the periphery of circumferentially outward-biased
spring pieces or arms 164 of indexing disk 162. These teeth engage
into a series of detents 152 disposed on the inner aspect of the
receptacle 151. With rotation of disk 162, the spring pieces
deflect inward, and then slip into the next detent available to
them.
This particular embodiment of a stabilizable articulation actuator
has two teeth 165 on each arm or spring piece of the indexing disk.
There are two series of corresponding detents 152 on the inner
aspect of the receptacle; each series has eight detents. This
arrangement of teeth and corresponding detents supports a total of
seven stable rotatable positions, a central neutral position, and
three positions on either side of the neutral position. Embodiments
of the stabilizable articulation actuator may have fewer or more
teeth and fewer or more detents. Typically, however, the
arrangement results in an uneven number of stable rotatable
positions, i.e., a central neutral position (at zero degrees, such
that the lever is at an orthogonal position with respect to the
shaft) and an equal number of stable rotated positions on either
side of neutral. It can be seen that the two spring piece arms are
arranged circumferentially opposite each other. This arrangement
creates a stable centering of inwardly directed forces, which
contributes to a balanced rotational movement around central lever
engagement post 168. Embodiments of the stabilizable articulation
actuator include arrangements of the rotational stabilizing disk
with more than two outwardly biased arms that support
detent-engaging teeth, such arms generally distributed at
equidistant intervals.
Embodiments of the stabilizable articulation actuator make use of a
variable resistance to rotation within the available arc of
rotation. Positions in an arc of rotation that require a relatively
high degree of force to move through represent positions where the
degree of rotation is stable, and such positions of stabilizable
articulation actuator stability translate into positions of
articulation angle stability at the end effector. In contrast,
positions or portions of the rotational arc that provide relatively
small resistance to rotation are not rotationally stable, and
generally represent a rotational zone intervening between the
positions of rotational stability.
In general, the arc of the rotation of the stabilizable
articulation actuator is about the same as the arc of articulation
of the articulable joint, and, by extension, the arc of
articulation of the end effector. For example, in some of the
embodiments described here, the stabilizable articulation actuator
and the articulable joint/end effector all exercise movement within
an arc of about 90 degrees, i.e., arcs of about 45 degrees on
either side of a neutral position.
Rotation of the indexing disk 162 by the finger operable lever 235
requires a relatively large force, for example about 2 lb.
pound-inches to about 15 pound-inches, in order to rotate the
indexing disk out of a stable position which occurs when teeth of
the indexing disk are engaged in complementary detents. Relatively
little force, for example less than about 2 lb. pound-inches is
required to rotate the indexing disk when teeth of the disk are in
positions between detents. Even the relatively large force required
to move the disk out of a stable angle position can be provided by
normal levels of finger pressure, as applied to the finger operable
lever. Note that the relatively large force is a characterization
of the force required to rotate the indexing disk out of a stable
position as being less than that required to rotate the indexing
disk when its teeth are positioned between the indented aspect of
the detents. Nevertheless, the relatively large force is within the
range of easy operability of the finger operable lever in a manual
way. Inasmuch as the mechanism can be easily pushed through a
stable angle position, and inasmuch as such movement is included in
normal operation of the mechanism, the stabilizable articulation
actuator can be understood as a substantially non-locking
system.
FIG. 20 also shows spring plate 170, as an example of a cable
tensioning mechanism 170, and helps to convey an understanding of
its role. In this view, disk 162 has been rotated clockwise from a
neutral position such that the upper portion (per this view) of
lever crossbar 235 is moved proximally, and the lower portion of
the crossbar has been moved distally. By such action, the upper (by
this view) cable 34a is under a relatively greater degree of
tension than the lower cable 34b. In the absence of a compensatory
mechanism, in this position, cable 34b would accumulate slack, and
create imprecision in the actuation of articulating the articulable
distal joint (not seen in this view). Spring plate 170, however,
provides compensation that maintains a balance of tension between
the two cables. It can be seen that the resilience of the spring
plate is calibrated appropriately such that the proximal ends of
cables 34a and 34b, outfitted with terminal balls 34c, are
maintained at a distance from the base provided by lever crossbar
235. Further visible in this view are stabilizing tabs 237,
positioned on the proximal aspect of crossbar 235. These tabs
stabilize the lateral position of the spring plate during rotation.
A further view of this aspect of the technology is seen in FIG.
27.
FIG. 21 provides a top view of an isolated portion of a
stabilizable articulation actuator 190 includes a finger lever 233,
indexing disk 162, and tension cables 34a and 34b. FIG. 22 provides
a top view with a slight proximal-looking angle of an exposed base
portion of a stabilizable articulation actuator positioned within
shaft rotator 141, showing the well or receptacle portion 151 into
which a rotational stabilizable disk may be seated. Cross-struts or
spokes 144 are arranged across the bottom of well 151. Detents 152
are arranged on the inner aspect of the receptacle or well 151.
FIG. 23 is an exploded top view with a slight distal-looking
perspective of a stabilizable articulation actuator, showing the
arrangement by which indexing disk 162 is rotatably seated into
receptacle 151, which is housed in shaft rotator 141. Finger
operable lever 233 is positioned above indexing disk 162, and
spring plate 170 is positioned above the disk. A central pin 166
rotatably secures disk 162 within the receptacle, and secures the
attachment of finger operable lever 233 within the assembled
actuator. The bottom of pin 166 is seated in the receptacle in hole
159, it passes through the indexing disk through central disk hole
169, and the top of the pin terminates within a central hole 239 in
the lever.
FIG. 24 is a perspective view of an indexing or rotational position
stabilizable disk 162 constructed according to aspects of the
technology, this embodiment comprising two spring portions or arms
164 that are biased in a circumferentially outward direction. Teeth
165 are positioned on the periphery of spring pieces 164. A central
hole is positioned to accommodate a central mounting pin (see FIG.
23). Lever engagement posts 168 are positioned on the upper surface
of the disk to provide connection sites for a finger operable
lever.
FIG. 25 is a perspective view of an isolated portion of the device
that that shows the cooperative arrangement of a finger operable
lever 233, a cable tension mechanism in the form of spring plate
170, and actuating wires 34a/34b that transit through cable transit
holes 236 within the finger operable lever 233. Actuating cables
34a/34b communicate with a distally positioned articulable joint as
seen in FIGS. 1, 2, 15, and 17.
FIG. 26 is a front-facing perspective view of an aspect of a cable
tensioning mechanism portion 170 of the stabilizable articulation
actuator of the device. This particular embodiment of the cable
tensioning mechanism comprises a spring plate with outward-facing
slots 172 are configured to accommodate the proximal ends of
tension cables 34a/34b, as seen in FIG. 25. Inward facing slots 174
are configured to accommodate stabilizing tabs positioned on a
finger-operable lever, as seen in FIG. 27. The open-facing aspect
of these slots is advantageous for ease in assembly of an
electrosurgical device, and does not incur any loss of performance
compared to the performance that would be provided by a
circumferentially fully enclosed hole configuration.
FIG. 27 is a side view of a spring plate 170 aligned against a
crossbar portion 235 of a finger operable lever. Shown in this view
are stabilizing tabs 237 positioned on the proximal side of the
crossbar, and inserted into inward facing slots 174. When the
finger-operable lever is in a rotated position, these tabs, in
position within the inward facing slots, prevent lateral slippage
of the spring plate in the direction of the proximally pulled arm
of the lever. This dynamic can be seen in FIG. 20, where the lower
arm (in this view) of the spring plate is being held in place by a
stabilizing tab against a ledge provided by an inward facing
slot.
The spring plate shown in FIGS. 26 and 27 is provided as an example
of a cable tensioning mechanism; the arrangement of the spring
plate with the crossbar of the finger-operable lever is but one of
several arrangements that are also included as embodiments of the
technology. The cable tensioning mechanism may be affixed to the
finger operable lever, or it may be secured to the finger operable
lever in an unfixed manner, as in the illustrated embodiment, where
the tension of cables 34a/34b, in conjunction with terminal balls
34c, maintains the attachment of the spring plate against the
lever. Additional embodiments of the technology include finger
operable lever and a cable tensioning mechanism as an integral
element. The arrangement depicted FIG. 27 is advantageous in terms
of ease of assembly.
FIG. 28 is a flow diagram of an aspect of a method for articulating
an articulable joint and stabilizing it at a desired angle of
articulation. Steps depicted in FIG. 28 show movements that
ultimately articulate an end effector, and show a transition of
moveable states to stabilized states that support the end effector
in a particular angle of articulation. The diagram depicts movement
associated with articulation from a rotational movement of the
rotational actuator, including rotation of a finger operable lever
and associated rotation of a rotationally stabilizable disk,
translational movement (in distal and proximal directions) of force
transfer cables, and articulating movement of an articulable joint
and, finally, articulating movement of a set of jaws. The
rotational position of the rotationally stabilizable disk occurs
within a well, and includes rotation of a set of teeth through
alternating portions of a rotatable arc wherein the teeth are
engaged within (engaged) or between detents (unengaged) with a
series of complementary detents. A position in which the teeth are
engaged in a detent (in some embodiments, two or more adjacent
teeth in two or more adjacent detents) represents a stable position
that manifests as a point of rotational resistance that is felt by
an operator rotating the finger operable lever. The stabilization
of the lever consequently stabilizes the translational movement of
the force transfer cables, which in turn stabilizes the articulated
angle of the articulable joint, which, in turn, stabilizes the
articulated angle of the jaws.
Unless defined otherwise, all technical terms used herein have the
same meanings as commonly understood by one of ordinary skill in
the art of surgery, including electrosurgery. Specific methods,
devices, and materials are described in this application, but any
methods and materials similar or equivalent to those described
herein can be used in the practice of the present technology. While
embodiments of the technology have been described in some detail
and by way of illustrations, such illustration is for purposes of
clarity of understanding only, and is not intended to be limiting.
Various terms have been used in the description to convey an
understanding of the technology; it will be understood that the
meaning of these various terms extends to common linguistic or
grammatical variations or forms thereof. It will also be understood
that when terminology referring to devices or equipment, that these
terms or names are provided as contemporary examples, and the
technology is not limited by such literal scope. Terminology that
is introduced at a later date that may be reasonably understood as
a derivative of a contemporary term or designating of a hierarchal
subset embraced by a contemporary term will be understood as having
been described by the now contemporary terminology. Further, while
some theoretical considerations may have been advanced in
furtherance of providing an understanding of the technology, the
appended claims to the technology are not bound by such theory.
Moreover, any one or more features of any embodiment of the
technology can be combined with any one or more other features of
any other embodiment of the technology, or with any technology
described in the patent applications or issued patents that have
been incorporated by reference, without departing from the scope of
the technology. Still further, it should be understood that the
technology is not limited to the embodiments that have been set
forth for purposes of exemplification, but is to be defined only by
a fair reading of claims appended to the patent application,
including the full range of equivalency to which each element
thereof is entitled.
* * * * *
References